Researchers in recent years have been studying the opioid epidemic and rates of overdose deaths, looking for some explanation for the high rates in the past few decades. A new study, published last month in the journal Science, suggests that the high rates of drug overdose deaths have an even greater underlying cause than just the opioid epidemic.

Overdose Trends in the United States

Currently, opioids (including prescription opioids, heroin, and synthetic opioids such as fentanyl and its chemical analogs) are the main causes of overdose deaths in the United States, leading the U.S. government to declare the opioid crisis to be a public health emergency (U.S. Department of Health and Human Services). In 2016, an overdose death occurred every 8 minutes.

According to the CDC:

  • More than 72,000 Americans died from drug overdoses in 2017, including illicit drugs and prescription opioids—a 2-fold increase in a decade
  • The sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids) with nearly 30,000 overdose deaths
  • From 2002 to 2017 there was a 22-fold increase in the total number of deaths related to synthetic opioids such as fentanyl
  • From 2002 through 2017, there was a 7.6-fold increase in the total number of deaths related to heroin
  • Every day, 174 people in the United States die from drug overdoses

Overdose Rates Follow Longstanding Trends

A new study, done by researchers from the University of Pittsburg, reviewed trends of drug overdoses from 1979 to 2016. They concluded that overdose deaths followed an exponential trajectory over those years, suggesting a connection to “larger societal problems like alienated communities and an increasingly disaffected population.” According to the study’s authors, overdose deaths steadily doubled about every nine years, long before the opioid epidemic began in the 1990s.

“This smooth, exponential growth pattern caught us by surprise,” Dr. Donald S. Burke, senior author and dean of the University of Pittsburgh Graduate School of Public Health, told ABC News. “It can be hard to grasp what exponential growth really means, but you can think of it as a nuclear explosion: you start with 2 [deaths due to drug overdose], then 4, then 8, then 16, and so on.”

“It implies that there are other forces at work, besides the specific drugs,” said Burke. “The forces are broader and deeper than we thought, including social determinants of health and technological determinants of health. The drugs have become cheaper over the years and their delivery systems have become more efficient… These factors increase drug availability. People are losing a sense of purpose in their lives and there has been the dissolution of communities, making people more susceptible to using drugs—increasing demand.”

Solving Underlying Issues

What does this mean for those working to address and prevent the high rates of opioid abuse and addiction in the United States? Treatment programs are of the highest priority because they do help people to stop using, overcome their addiction, and establish a positive course for their future. Naloxone distribution and availability is also important, as it has the ability to reverse opioid overdoses and save lives. However, in the long run, more must be done, according to study authors.

“If we solve the [opioid] sub-epidemic, will there be another sub-epidemic that comes on its heels?” Burke said. “If we don’t address the social determinants of health that underlie drug use and addiction, there’s a good possibility that the drug overdoses will start to emerge again.”

Social issues such as lack of education, poverty, lack of purpose, and failed sense of community all lead to drug abuse. As individuals continue to feel isolated, they begin searching for ways to feel whole again, and often turn to drugs and alcohol to self-medicate. Study researchers encourage our society to think beyond the general parameters of public health and to instead look at the broader aspects of society. “Why don’t people feel a sense of purpose? Why do people not have a sense of community? Why do we appear to be living in an emerging economic caste system in the United States?” said Burke. “These are the issues that need to be addressed. They are in the realms of education, employment, housing… They are not easy problems.”